MEDICARE: THERESA FERNANDEZ

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	S022051	AZ
2	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	78288	CA

General Provider Information

NPI Number	:	1770037137
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THERESA FERNANDEZ

Provider Business Mailing Address
First Line	:	1770 W CARSON ST
Second Line	:
City	:	TORRANCE
State	:	CA
Zip	:	90501-2821
Country	:	US
Telephone Number	:	310-787-8861
Fax Number	:

Provider Business Practice Location Address
First Line	:	1770 W CARSON ST
Second Line	:
City	:	TORRANCE
State	:	CA
Zip	:	90501-2821
Country	:	US
Telephone Number	:	310-787-8861
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/15/2016
Last Update Date	:	05/15/2026

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Directions to “ THERESA FERNANDEZ ” Practice Location

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